Cerebral small vessel disease and effects of intensive versus standard blood pressure treatment on cardiovascular outcomes and adverse events

Topic: Risk, prevention and care in population studies

The mean age of the participants was 68 ± 9 years and 39% were female. In adjusted models, adults with WMHv above the median had an increased risk of the primary cardiovascular composite outcome [hazard ratio (HR) 2.59, 95% confidence interval (CI) 1.39, 4.81], all-cause mortality (HR 2.06, 95% CI 0.97, 4.37), and mild cognitive impairment or probable dementia (HR 1.76, 95% CI 0.99, 3.13). While the effects of intensive versus standard blood pressure treatment were similar for most outcomes by WMHv, intensive treatment was associated with a higher risk for mild cognitive impairment or probable dementia among adults with a WMHv above the median (HR 2.36, 95% CI 1.20, 4.66), but not among adults with a WMHv below the median (p-value for interaction = 0.09). In this posthoc analysis of SPRINT, adults with a higher WMHv were at a higher risk for adverse cardiovascular and cognitive outcomes. Among these adults, intensive blood pressure treatment reduced cardiovascular events, while its effects on the risk of cognitive impairment or dementia in this subgroup merit further study.

Key findings

• The mean age of the participants was 68 ± 9 years and 39% were female.
• In adjusted models, adults with WMHv above the median had an increased risk of the primary cardiovascular composite outcome [hazard ratio (HR) 2.59, 95% confidence interval (CI) 1.39, 4.81], all-cause mortality (HR 2.06, 95% CI 0.97, 4.37), and mild cognitive impairment or probable dementia (HR 1.76, 95% CI 0.99, 3.13).
• While the effects of intensive versus standard blood pressure treatment were similar for most outcomes by WMHv, intensive treatment was associated with a higher risk for mild cognitive impairment or probable dementia among adults with a WMHv above the median (HR 2.36, 95% CI 1.20, 4.66), but not among adults with a WMHv below the median (p-value for interaction = 0.09).
• In this posthoc analysis of SPRINT, adults with a higher WMHv were at a higher risk for adverse cardiovascular and cognitive outcomes.
• Among these adults, intensive blood pressure treatment reduced cardiovascular events, while its effects on the risk of cognitive impairment or dementia in this subgroup merit further study.

Why it matters

In this post-hoc analysis, adults with white matter hyperintensity volume above the median had higher risk of cardiovascular events, death, and mild cognitive impairment or probable dementia. Intensive blood pressure treatment reduced cardiovascular events in this group, but was associated with a higher risk of mild cognitive impairment or probable dementia, which the authors say merits further study.

Study details

• Study designpost-hoc analysis
• Participants759
• Effect sizeHR 2.06; HR 1.76; HR 2.36
• Evidence strengthLow

Read the original

• DOI: 10.1097/hjh.0000000000004093
• PubMed: 40586237
• Original source →
• Free full text: PubMed Central →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{reddy2025-40586237,
  author  = {Reddy, Mallika and Li, June and Pajewski, Nicholas M. and Gaussoin, Sarah A. and Bryan, Robert Nick and Nasrallah, Ilya M. and Tamura, Manjula Kurella},
  title   = {{Cerebral small vessel disease and effects of intensive versus standard blood pressure treatment on cardiovascular outcomes and adverse events}},
  journal = {Journal of Hypertension},
  year    = {2025},
  doi     = {10.1097/hjh.0000000000004093},
  pmid    = {40586237},
  url     = {https://doi.org/10.1097/hjh.0000000000004093}
}

Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial JAMA · 2019-02-01 · usefulness score 77/100 · Getting a diagnosis
• The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT) Clinical trials (London, England) · 2014-06-05 · usefulness score 61/100 · Risk factors

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